| (a) A managed care organization (MCO) must provide
comprehensive, timely, and cost-effective diagnostic, screening, and
treatment services for the medical, vision, hearing, and dental needs
of Medicaid managed care program members under the age of 21, at a
level and frequency that meet the requirements of the federal EPSDT
program, as determined by the Health and Human Services Commission
(HHSC). These requirements will be contained in all contracts, as
applicable to each managed care program.
(b) An MCO must make available special training about
Texas Health Steps (THSteps) benefits and goals to all providers of
health and dental services contracting with the MCO to providers'
staffs, and to all employees and contractors of the MCO who will provide
oral presentations or marketing to members or prospective members.
To fulfill this requirement, the MCO may use the training programs
created by HHSC or its contractors, or the MCO may create its own
training programs. Any training program created by the MCO under this
subsection must meet the requirements of and be approved by HHSC.
(c) An MCO must coordinate and cooperate with HHSC
in developing effective outreach, access, and monitoring systems to
ensure that all qualified members receive THSteps benefits.
(d) The managed care programs of participating MCOs
are intended to complement and enhance the effectiveness and availability
of THSteps benefits in the service areas. HHSC will not delegate the
responsibility and accountability for monitoring and ensuring that
THSteps benefits are available and accessible to all eligible children.
|
| Source Note: The provisions of this §353.413 adopted to be effective December 18, 1996, 21 TexReg 11822; transferred effective September 1, 2001, as published in the Texas Register May 24, 2002, 27 TexReg 4561; amended to be effective August 10, 2005, 30 TexReg 4466; amended to be effective September 1, 2006, 31 TexReg 6629; amended to be effective March 1, 2012, 37 TexReg 1283 |
